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Universally Poor Outcomes of Pediatric Traumatic Arrest: A Prospective Case Series and Review of the Literature

Brindis, Seth L. MD*†‡; Gausche-Hill, Marianne MD*†‡; Young, Kelly D. MD*‡§; Putnam, Brant MD†‡∥

doi: 10.1097/PEC.0b013e31822255c9
Original Articles

Objective: Few data are available on traumatic cardiopulmonary arrest in children. Efforts at resuscitation typically result in heavy utilization of finite resources with little understanding of which characteristics, if any, may be associated with success. The objectives of this study were to describe the outcome of children in traumatic cardiac arrest and to identify patients for whom aggressive resuscitation may or may not be warranted.

Methods: Data were analyzed from a previous study of prehospital pediatric airway management in Los Angeles and Orange Counties, Calif, over a 33-month period. Patients included in this secondary analysis were younger than 13 years and found pulseless and apneic after having had an injury. Data sources included prospective, phone interviews with paramedics after transfer of care to the receiving facility, and chart review to determine outcome. Two main outcomes were assessed: survival and neurological function as measured by the Pediatric Cerebral Performance Category.

Results: The emergency medical services responded to 118 traumatic arrests during the study period. Of these victims, only 6 (5%) survived. Median Injury Severity Score was 25 with an interquartile range of 16 to 75. The survivors all were neurologically impaired with a median Pediatric Cerebral Performance Category of 5 (interquartile range, 4-5).

Conclusions: Children who had trauma resulting in cardiac arrest have universally poor outcomes, and survivors have severe neurological compromise. We are unable to identify a subset of patients for whom aggressive resuscitation is indicated. This is the largest prospective study of pediatric traumatic arrest to date.

From the *Department of Emergency Medicine, Harbor UCLA Medical Center; †Department of Medicine, David Geffen School of Medicine at UCLA; ‡Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center; §Department of Pediatrics, David Geffen School of Medicine at UCLA; and ∥Department of Surgery, Harbor UCLA Medical Center, Torrance, CA.

Reprints: Seth L. Brindis, MD, Department of Emergency Medicine, Harbor UCLA Medical Center, 1000 W Carson St, Box 21, Torrance, CA 90509 (e-mail: seth.brindis+harbor@gmail.com).

The authors acknowledge grant support to Marianne Gausche-Hill, MD, from the following agencies: Agency for Health Care Policy and Research and the Health Resources and Service Administration (grant 1RO1 HS 9166); the State of California Emergency Medical Services (EMS) Authority under Special Projects Grants (grants EMS 2031, 3036, 4051, 5034); and the Maternal and Child Health Bureau in collaboration with the National Highway Traffic Safety Administration, Health Resources and Services Administration (grant MCH-064004).

Abstract presented at the American Academy of Pediatrics National Conference and Exhibition, Washington, DC, October 17, 2009.

© 2011 Lippincott Williams & Wilkins, Inc.